Ins 8.71(2)(a)(a) A medical or osteopathic physician, podiatrist, physical therapist or physician’s assistant licensed or certified under ch. 448, Stats.
Ins 8.71(2)(b)(b) A psychologist licensed under ch. 445, Stats.
Ins 8.71(2)(c)(c) A chiropractor licensed under ch. 446, Stats.
Ins 8.71(2)(d)(d) A nurse midwife certified under s. 441.15, Stats.
Ins 8.71(2)(e)(e) A nurse practitioner licensed under ch. 441, Stats.
Ins 8.71(2)(f)(f) A nurse licensed under ch. 441, Stats., who is certified as a nurse anesthetist by the American association of nurse anesthetists.
Ins 8.71(2)(g)(g) A dentist licensed under ch. 447, Stats.
Ins 8.71 HistoryHistory: Cr. Register, June, 1993, No. 450, eff. 7-1-93; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register April 2004 No. 580.
Ins 8.72Ins 8.72Basic benefits. Subject to the limitations and restrictions under s. Ins 8.75 and copayments and coinsurance under s. Ins 8.77, each plan shall provide coverage for all of the following, if medically necessary:
Ins 8.72(1)(1)Professional services by a health care provider acting within the scope and limitations of his or her license or certificate or a person acting under the direction of a health care provider, including all of the following:
Ins 8.72(1)(a)(a) Office, outpatient, inpatient and emergency room visits including treatment rendered during those visits.
Ins 8.72(1)(b)(b) Surgical services including postoperative care following inpatient or outpatient surgery.
Ins 8.72(1)(c)(c) Services of an assistant surgeon if necessary to perform surgery.
Ins 8.72(1)(d)(d) Anesthesia services.
Ins 8.72(2)(2)Hospital care, including all of the following:
Ins 8.72(2)(a)(a) Semi-private room, board and ancillary services and supplies that are generally provided to hospital inpatients.
Ins 8.72(2)(b)(b) Confinement in an intensive care or coronary care unit of a hospital.
Ins 8.72(2)(c)(c) Outpatient medical care and treatment.
Ins 8.72(2)(d)(d) Medical care and treatment provided in a hospital emergency room.
Ins 8.72(3)(3)Medical care and treatment provided in an ambulatory surgery center, as defined in 42 CFR 416.2.
Ins 8.72(4)(4)Outpatient x-ray, laboratory and other diagnostic tests.
Ins 8.72(5)(5)Confinement in a skilled nursing home licensed under subch. I of ch. 50, Stats.
Ins 8.72(6)(6)Services provided by a home health agency licensed under s. 50.49, Stats.
Ins 8.72(7)(7)Care provided by a hospice licensed under subch. VI of ch. 50, Stats.
Ins 8.72(8)(8)Local ground licensed ambulance services.
Ins 8.72(9)(9)Physical therapy.
Ins 8.72(10)(10)Rental and purchase of durable medical equipment and supplies.
Ins 8.72(11)(11)Prescription drugs.
Ins 8.72(12)(12)Reconstructive surgery which is either of the following: